소아 Henoch-$Sch{\ddot{o}}nlein$ 자반증에서의 항호중구 항체

최지나,신재일,이재승,김현숙,Choi, Ji-Na,Shin, Jae-Il,Lee, Jae-Seung,Kim, Hyon-Suk 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.2

목 적 : Henoch-$Sch{\ddot{o}}nlein$ 자반증에서 항호중구 항체에 대한 외국의 여러 논문이 있었으나 이들은 대조적인 연구결과를 보였고, 국내에서는 Henoch-$Sch{\ddot{o}}nlein$ 자반증 환아를 대상으로 한 항호중구 항체의 연구가 없었다. 따라서 한국 소아 Henoch-$Sch{\ddot{o}}nlein$ 자반증에서 항호중구 항체의 임상적인 의의를 알아보고자 본 연구를 시행하였다. 방 법 : 2007년 5월부터 2008년 8월까지 신촌 세브란스병원 소아과에 내원하여 Henoch-$Sch{\ddot{o}}nlein$ 자반증으로 진단받은 30명의 환아들을 대상으로 의무기록을 후향적으로 조사하여 분석하였고, 일반적인 특징으로 나이, 성별, 자반증 등의 증상등을 조사하였다. 검사 소견으로는 백혈구수, 혈소판수, 혈침 속도, Anti-streptolysin O titer, 대변 잠혈 검사, 혈청 면역 글로불린(IgG, IgA, IgM), 혈청 보체(C3, C4), 항핵 항체, 항호중구 항체(c-ANCA, p-ANCA)를 조사하였다. 결 과 : 총 30명의 환아중 남자가 13명, 여자가 17명이었고 평균 연령은 6.0${\pm}$1.9세(범위: 5-12세)였다. 자반은 모든 환아(100%)에서 관찰되었고, 복통은 20 명(67%), 관절통은 17명(57%), 신침범은 11명(37%)에서 관찰되었다. Anti-streptolysin O titer는 검사한 환아 15명 중 1명(7%)에서 증가된 소견을 보었고, 혈청 IgA 수치는 모든 환아에서 증가되지 않았다. 간접면역형광법으로 시행한 항호중구 항체 검사에는 오직 한 명(3%)에서만 p-ANCA가 약양성 소견을 보였으나 이는 추적 검사시 음성으로 전환되었고 나머지 환아에서는 c-ANCA, p-ANCA가 모두 음성 소견을 보였다. 결 론 : 항호중구 항체는 소아 Henoch-$Sch{\ddot{o}}nlein$ 자반증에서 진단적 혹은 면역학적으로 특이한 검사소견은 아닌 것으로 보이며, 이는 항호중구 항체가 소아 Henoch-$Sch{\ddot{o}}nlein$ 자반증의 병인과 연관성이 없음을 암시한다. Purpose : There have been some reports on the prevalence of positive antineutrophil cytoplasmic antibody(ANCA) in Henoch-$Sch{\ddot{o}}nlein$ purpura(HSP), but the results were conflicting. We performed this study to evaluate the clinical significance of ANCA(c-ANCA and p-ANCA) in Korean children with HSP. Methods : The medical records of 30 patients(13 boys and 17 girls) aged 6.0$\pm$1.9(5-12) years with a clinical diagnosis of HSP based on the EULAR/PReS criteria were reviewed retrospectively. From the years 2007 to 2008, the sera from children with acute HSP were tested for antineutrophil cytoplasmic antibodies(ANCA). The target antigens of these autoantibodies are proteinase 3(c-ANCA) or myeloperoxidase(p-ANCA). Results : Palpable purpura was seen in all 30 patients(100%), abdominal pain in 20(67%), arthralgia in 17(57%), and renal involvement in 11(37%). Laboratory findings showed leukocytosis in 4 patients(13%), thrombocytosis 18 in(60%), and elevated erythrocyte sedimentation rate in 18(60%). Anti-streptolysin O titers were elevated in 7% of the patients and no patient showed elevation of serum IgA level. The sera from 29 patients were negative for c-ANCA and p-ANCA by indirect immunofluorescence, but only one patient had weakly positive results, which became negative at follow-up. Conclusions : We conclude that c-ANCA or p-ANCA is not an important serologic marker in children with HSP, because it was neither diagnostically nor immunologically specific in children with HSP. These results suggest that ANCA are not involved in the pathogenesis of HSP in children.

Henoch-$Sch{\ddot{o}}nlein$ 자반증에서 항인지질 항체의 임상적 의의

박은정,백지영,신재일,이재승,김현숙,Park, Eun-Jung,Baek, Ji-Young,Shin, Jae-Il,Lee, Jae-Seung,Kim, Hyon-Suk 대한소아신장학회 2009 Childhood kidney diseases Vol.13 No.2

목적 : Henoch-$Sch{\ddot{o}}nlein$ 자반증에서 항인지질 항체에 대한 연구가 외국에서 몇몇 보고되고 있지만 국내에서는 소아 환자를 대상으로 한 연구가 거의 없는 실정이며 또한 항인지질 항체가 양성인 그룹과 음성인 그룹을 비교하여 연구한 논문은 아직 없는 상태이다. 따라서 한국 소아 Henoch-$Sch{\ddot{o}}nlein$ 자반증에서 항인지질 항체가 양성인 환아의 항인지질 항체의 임상적 의의를 알아보고자 본 연구를 시행하였다. 방법 : 2007년 1월부터 2009년 6월까지 신촌 세브란스 병원 소아청소년과에 내원하여 Henoch-$Sch{\ddot{o}}nlein$ 자반증으로 진단받은 62명의 환아를 대상으로 의무기록을 후향적으로 조사하여 분석하였다. 환아의 일반적인 특징으로 성별, 나이, 복통, 관절통과 자반증 등의 임상 증상을 조사하였고, 검사 소견으로는 백혈구수, 혈색소, 혈소판수, 호산구수, C-반응 단백, 혈침 속도, 단백뇨, 대변 잠혈 검사, 혈청 면역 글로불린(IgG, IgA, IgM, IgE), 혈청 보체(C3, C4), 항핵 항체(ANA), 알부민과 항인지질 항체(루프스 항응고인자, 항카디오리핀 항체, 항${\beta}$ 2GPI 항체) 등을 조사하였다. 결과 : 총 62명의 환아중 남녀 각각 31명이었고 평균 연령은 $6.0{\pm}3.1$세(범위: 1-16세)였다. 루프스 항응고인자 양성인 그룹과 음성인 그룹으로 나누어 비교한 결과 복통, 자반증, 관절통, 신염 등의 임상 증세에서는 두 그룹 간에 통계적으로 유의한 차이가 없는 걸로 나타났으나 검사 소견을 비교하였을 때 양성인 그룹에서 C-반응 단백($4.3{\pm}7.2$ mg/dL vs. $1.3{\pm}1.8$ mg/dL, P=0.035), 혈침 속도($37.5{\pm}26.2 mm/hr vs. $25.1{\pm}22.6$ mm/hr, P=0.039), IgM ($148.1{\pm}48.4$ mg/dL vs. $114.9{\pm}41.5$ mg/dL, P=0.024), C3 ($143.1{\pm}21.9$ mg/dL vs. $129.7{\pm}24.5$ mg/dL, P=0.048), C4 ($30.9{\pm}6.3$ mg/dL vs. $24.9{\pm}7.8$ mg/dL, P=0.002)가 통계학적으로 유의하게 높았다. 결론 : Henoch-$Sch{\ddot{o}}nlein$ 자반증에서 루프스 항응고인자는 29%에서 양성 소견을 보였으며 양성인 그룹에서 염증 인자인 C-반응단백, 혈침 속도 그리고 IgM, C3, C4 수치가 유의하게 높게 측정되었다. 이것은 루프스 항응고인자가 Henoch-$Sch{\ddot{o}}nlein$ 자반증에서 질병의 활성과 병인에 어떤 역할을 수행함을 암시한다고 볼 수 있다. Purpose : We performed this study to evaluate the incidence and clinical significance of antiphospholipid antibodies (aPL Ab) in Korean children with Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP). Methods : The medical records of 62 patients (31 boys and 31 girls) aged $46.0{\pm}3.1$ (1-16) years with a clinical diagnosis of HSP based on the EULAR/PReS criteria were reviewed retrospectively. From the years 2007 to 2009, the sera from children with acute HSP were tested for aPL Ab such as LA, anti-cardiolipin antibody and anti-${\beta}_2$ glycoprotein I antibody. Results : LA was positive in 18 (29%) of the 62 patients with HSP and We divided the patients into the two groups LA positive group (N=18) and LA negative group (N=44). There were no significant differences between the two groups with regard to abdominal pain, arthralgia and renal involvement, but LA positive group had significantly higher C-reactive protein ($4.3{\pm}7.2$ mg/dL vs. $1.3{\pm}1.8$ mg/dL, P=0.035), erythrocyte sedimentation rate ($37.5{\pm}26.2$ mm/hr vs. $25.1{\pm}22.6$ mm/hr, P= 0.039), IgM ($148.1{\pm}48.4$ mg/dL vs. $114.9{\pm}41.5$ mg/dL, P=0.024), C3 ($143.1{\pm}21.9$ mg/dL vs. $129.7{\pm}24.5$ mg/dL, P=0.048) and C4 levels ($30.9{\pm}6.3$ mg/dL vs. $24.9{\pm}7.8$ mg/dL, P=0.002) compared with LA negative group. Conclusion : We found that the incidence of positive aPL Ab tests was relatively higher in Korean children with HSP and the presence of aPL Ab was associated with acute inflammatory process of HSP. These results suggest that the aPL Ab are involved in the pathogenesis of HSP in children.

Urinary N-Acetyl-beta-D-Glucosaminidase and beta 2-Microglobulin in Children with Various Renal Diseases

윤소진,신재일,이재승,김현숙,Yoon, So-Jin,Shin, Jae-Il,Lee, Jae-Seung,Kim, Hyon-Suk Korean Society of Pediatric Nephrology 2008 Childhood kidney diseases Vol.12 No.2

목 적 : 요 중 N-acetyl-beta-D-glucosaminidase(NAG) 와 beta 2-microglobulin(B2M) 은 신세뇨관 간질 손상의 표적으로 생각된다. 이 연구의 목적은 다양한 신장 질환 환아 에서 요 중 NAG 와 B2M 수치를 검사해 보는 것이다. 방 법: 우리는 21명의 환아(8.9$\pm$4.5세, 남:녀=14:7)를 조사해서 세 군으로 분류하였다: I군(스테로이드에 반응하는 신증후군 환아-4명), II군(다양한 종류의 사구체 신염 환아-4명), III군(정상뇨 또는 비사구체성 신장 질환 환아-13명). 결 과: I군과 II군에서의 요 중 NAG 수치는 III군에서보다 유의하게 높았다.(19.4$\pm$11.5와 30.0$\pm$30.1 vs. 4.7$\pm$3.9, P=0.01) 반면에 요 중 NAG 수치와 B2M 수치가 양의 상관 관계에 있음에도(r=0.49, P=0.03), 요 중 B2M 수치는 세 군에서 차이가 없었다. 요 중 NAG 와 B2M 수치는 모두 단백뇨, 혈중 알부민, 콜레스테롤과 상관관례를 보였다. 결 론: NAG 와 B2M 의 배설량은 스테로이드에 반응하는 신증후군 환아와 다양한 종류의 사구체 신염 환아에서 증가되어 있었다. 이는 이런 질환들에서 세뇨관 기능저하를 의미하는 것으로 보인다. Purpose : Urinary N-acetyl-beta-D-glucosaminidase(NAG) and beta 2-microglobulin(B2M) is considered to be a marker of tubulointerstitial injury. The aim of this study was to examine the urinary levels of NAG and B2M in children with various renal diseases. Methods : We studied 21 children(8.9$\pm$4.5 years, Male:Female=14:7) and they were divided into three groups: group I(steroid-sensitive nephrotic syndrome-4 patients), group II(various kinds of glomerulonephritis-4 patients), and group III(normal urinalysis or non-glomerular renal diseases-13 patients). Results : Urinary NAG levels in groups I and II were significantly higher than those in group III(19.4$\pm$11.5 and 30.0$\pm$30.1 vs. 4.7$\pm$3.9, P=0.01), while urinary B2M levels did not differ among the 3 groups, although urinary NAG levels were positively correlated with urinary B2M levels(r=0.49, P=0.03). Urinary NAG and B2M levels were all correlated with proteinuria(r=0.79, P<0.001 and r=0.68, respectively, P=0.001) serum albumin(r=-0.72, P<0.001 and r=-0.57, respectively, P=0.01) and cholesterol(r=0.58, P=0.006 and r=0.56, respectively, P=0.013) levels. Conclusions : Urinary excretions of NAG and B2M are increased in children with steroidsensitive nephrotic syndrome and various kinds of glomerulonephritis, suggesting tubular dysfunction might be present in these diseases.

류마티스양 관절염에서 CD20dim T 세포의 발현

이종욱 ( Jong Wook Lee ),이정운 ( Jung Woon Lee ),김현숙 ( Hyon Suk Kim ),권오헌 ( Oh Hun Kwon ),이수곤 ( Soo Kon Lee ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.2

Objective: This study was designed to investigate CD20dim expression on T cells between healthy control subjects and rheumatoid arthritis patients and to investigate the association between CD20dim T cells and clinical manifestations in rheumatoid arthritis. Methods: Peripheral bloods from twenty seven healthy controls and twenty six rheumatoid patients were evaluated by dual color immunophenotyping. We used IgG1a and IgG2a for negative control, then, divided T cells and B cells on CD3/CD19 combination. And we evaluated two subpopulation CD5+CD20dim T cell(CD20dim T cell) and CD5+CD20bright cell(CD5 B cell) on CD5/20 combination for comparison. In order to correlate the CD20dim T cell datas with patient`s clinical status, patients charateristcs such as age, disease duration, morning stiffness, rheumatoid factor (RF), and antinuclear antibody (ANA) were reviewed. Results: The mean percent positivity of T cells(CD3) and B cells(CD19) in 27 healthy control donors was 63.2±7.7%, and 11.4±2.6 %. The mean percentages of CD20dim T cell and CD5 B cell (Leu1) were 2.3±1.0% and 1.4±0.9% and upper limit of reference values of CD20dim T cells and CD5 B cells(Leu1) that calculated from normal healthy controls were 4.3% and 3.2 %. Compared with healthy controls, CD20dim T cells were significantly elevated in total patient groups (4.4±2.7%, p<0.01). and significantly increased more than upper limit of reference values in eleven of 26 patients. Compared with CD20dim T cells according to disease duration, disease duration of most patients(l0/11) with elevated CD20dim T cell were less than 2 years. Conclusion: The results indicated that CD20dim T cells were expressed at low levels in healthy controls but elevated levels of CD20dim T cells in rheumatoid arthritis patients were observed and close relationship to CD20dim T cells expression and disease duration was noted.

혈청 아디포넥틴 측정 키트(AdipoMark)의 개발과 심혈관질환 위험요인과의 관련성 연구

지선하(Sun Ha Jee),이승복(Seungbok Lee),민성식(Sungsik Min),박정용(Jungyong Park),김현숙(Hyon-Suk Kim),김상연(Sang Yeun Kim),윤지은(Ji Eun Yun),이선주(Sun Ju Lee),지은정(Eun Jung Jee),이희연(Hee Yeon Lee),송혜윤(Hye Yun Song) 한국역학회 2007 Epidemiology and Health Vol.29 No.2

  Purposes: To develop a rapid, sensitive, qualitative ELISA-kit for serum adiponectin and examine correlation with adiponectin and cardiovascular risk factors.   Methods: On the base of monoclonal antibodies against adiponectin, apply indirect ELISA to study the performance parameter of the kit. The correlation was examined between adiponectin and cardiovascular risk factors including waist circumference, body mass index, triglyceride, and HDL cholesterol.   Results: The limited concentration of detection of the ELISA-kit was 1㎍/㎖. Linearity with R&D system and AdipoGen with this ELISA-kit was acceptable: the linear equation with R&D system was y=1.0116x+0.4629 (R2=0.97) and linear equation with AdipoGen was y=0.9562x+1.1961 (R2=0.93), respectively. The average recovery rate of the ELISA-kit ranged 92 to 104%. The correlation coefficient of waist circumference with adiponectin was -0.2276 (p<0.0001) among men and -0.2328 (p<0.0001) among women.   Conclusion: This ELISA-kit was quick, sensitive, and stable and can be used to determine adiponectin in serum.

배양된 위암세포에 대한 Desferrioxamine 및 항암제의 병합 효과

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myoung Moon),김원호(Won Ho Kim),이관식(Kwan Sik Lee),김현숙(Hyon Suk Kim),권오헌(Oh Hun Kwon) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A Iron is essential for the growth of all cells including tumor cells because ribonucelotide reductase, a rate-limiting enzyme for DNA synthesis, requires the continual presence of oxygen and iron. Furthermore, it was reported that iron depletion causes tumor cell death but shows little cytotoxic effect on normal human diploid cells in vitro. Desferrioxamine (DFO), an iron-chelating agent, has also been reported to have antitumor activity on several cultured human cancer cell lines but has minimal cytotoxicity on normal human cells. Therefore, it was hypothesized that I)FO could be used as a potential anticancer regimen. This study was designed to investigate the combined effect of DFO and several an.ticancer chemotherapeutic agents, such as 5-fluorouracil (5-FU), adriamycin (ADR), and cisplatinum (DDP), against gastric cancer cell line (PHB). We measured cytotoxicity by MTT assay and evaluated the effects of the combinations by isobologram analysis. The results obtained were as foliows: IC50 of DFO, 5-FU, ADR, and DDP were 14.3 ug/mL, 1.2 ug/mL, 0.5 ug/mL, and 2.9 ug/mL, respectively. The combination of DFO with 5-FU showed a synergistic effect, but combination of DFO with ADR and DFO with DDP did not. We concluded that DFO, which showed an in vitro anticancer effect against cultured gastric cancer cells and showed a synergistic effect if combined with 5-FU, could be used as a potentiaI anticancer drug.

한국인의 혈청 아디포넥틴과 당뇨병 진단기준 설정에 관한 연구

지선하(Sun Ha Jee),이희연(Hee Yeon Lee),이선주(Sun Ju Lee),윤지은(Ji Eun Yun),지은정(Eun Jung Jee),송혜윤(Hye Yun Song),김상연(Sang Yeun Kim),박정용(Jungyong Park),김현숙(Hyon-Suk Kim) 한국역학회 2007 Epidemiology and Health Vol.29 No.2

  Background: As indicators of obesity, waist circumference (WC), body mass index (BMI), and adiponectin are well known risk factor for diabetes mellitus. The objectives of this study were to measure the independent association between these obesity indicators and diabetes and to examine the combined effect of these indicators on diabetes in a Korean population.   Methods: The WC, BMI, and serum adiponectin were measured in 6,505 healthy Koreans and were classified into tertile groups for men and women. The independent and combined associations of the obesity indicators with diabetes were measured using logistic regression analyses. Diabetes was defined as fasting serum glucose greater than 126㎎/dL or taking medication.   Results: Levels of adiponectin were inversely associated with BMI and WC and directly associated with age and high density lipoprotein cholesterol (HDL) cholesterol (P<0.001). After adjusting for age, WC, and other lifestyle factors, low levels of adiponectin were associated with an increased prevalence of diabetes. Further adjustment for HDL cholesterol and triglyceride attenuated this association in both men and women. The best cut-off value of adiponectin in terms of identifying the presence of diabetes was 5.5㎍/㎖ with a sensitivity and specificity of 46.7% and 63.9% for men and 9.5㎍/㎖ with a sensitivity and specificity of 68.2% and 55.2 for women.   Conclusions: These results suggest that adiponectin was associated with diabetes. The association was independent of WC and was partly modified by HDL and triglyceride. There were no effect modifications of adiponectin with WC on diabetes.

포르말린 처리 쥐뇌조직유래 불활화 한탄바이러스 백신(한타박스R) 2회 접종 후 혈중 중화항체 생성에 관한 연구

손영모,노혜옥,김현숙 대한감염학회 1998 감염 Vol.30 No.4

목 적 : 1990년 쥐 뇌조직에서 제조한 포르말린 불활성화 한탄바이러스 백신 (Hantvax, 녹십자)이 개발된 이래 국가 임시 예방접종 사업의 일환으로 소아와 성인을 대상으로 현재까지 6백만 도즈 이상이 접종되었다. 그러나 아직까지 국내에서 한타박스의 무작위, 위약 대조 임상 시험에 의한 백신의 효능 평가가 이루어지지 않았으며 인체내에서 중화 항체 반응에 대한 믿을만한 보고가 없었다. 따라서 본 저자들은 건강한 성인을 대상으로 한탄바이러스 백신을 2회 접종 후 중화 항체 반응에 대한 연구를 시행하였다. 대상 및 방법 : 건강한 성인 30명을 대상으로 4주 간격으로 2회 Hantavax (Lot No. 6001 및 2360002, 녹십자)를 삼각근에 0.5cc씩 근육주사 하였다. Hantavax는 ROK 84-105주를 0.05% 포르말린으로 불활화한 것으로 ELISA로 항원가 4096IU를 사용하였으며 백신전, 1차 접종 4주후, 2차 접종 4주후에 채혈한 90개의 혈청으로 검사를 시행하였다. 바이러스 중화항체 검사는 미육군전엽병연구소의 분자 미생물학과에 의뢰하여, 한탄바이러스 76-118주를 공격주로 사용하여 바이러스 (45-58 PFU) 50% 감소하는 최대 혈청 희석 농도를 중화 항체가로 하였다. 동일 혈청으로 본원 임상 병리과에서 응집 반응 검사 시약 (한탄디아, 녹십자)을 사용하여 한탄바이러스 항원에 응집 항체 검사를 시행하였다. 결 과 : 한탄바이러스 백신 2회 접종 후 측정한 중화항체 검사 결과 30명 중 5명에서 양전되어 항체 양전률은 16.7%였다. 중화항체가는 각각 1:320, 1:10, 1:10, 1:10, 1:40이었다. 응집 항체검사 결과 2회 접종후 양성률은 80.0%(24/30)이었다. 결 론 : 뇌조직 유래 포르말린 불홀성화 한탄바이러스 백신 (Hantavax)의 2회 접종 후 중화항체 생성율은 매우 낮으며 이에 대한 재평가가 필요할 것으로 사료된다. Background : Hemorrhagic fever with renal syndrome is a serious health problem in Korea. Formalin inactivated mouse brain-derived Hantaan virus vaccine (??) has been available since 1990 and recommended in national immunization programs for children and adults by the health authority. However, Hantavax has not been evaluated for efficacy in a randomized, placebo-controlled clinical trial and data on neutralizing antibody responses in human trials are limited. To investigate humoral immune responses to Hantavax, we studied volunteers immunized according to the recommended two dose schedule. Methods : With informed consent, 30 healthy adults were immunized with two doses of Hantavax 0.5 ml given intramuscularly 4 weeks apart. The monovalent vaccine, produced from the ROK 84-105 strain, is inactivated with 0.05% formalin and has an ELISA antigen titer of 4096. Sera were collected befre vaccination and 4 weeks after each dose for 90 samples from 30 vaccinees. Neutralizing antibodies were measured at United States Army Medical Research Institute of Infectious Disease by plaque reduction neutralization tests. Antibody titers were expressed as the highest serum dilution that reduced the standard viral dose Serum binding antibodies also were measured i a high density particle agglutination test (??) at Yonsei University. Results : Neutrazing antibodies were detected in only 5 of 30 vaccinees given two deses of Hantavax, yielding seroconversion rate of 16.7%. The endpoint titers of reactive sera were 1:10, 1:10, 1:10, and 1:40 respectively. The seroconversion rate measured by high density particle agglutination test was 80.0% (24/30). Conclusion : These results indicated that the poor neutralizing antibody response was observed and suggests that further evaluations of the protective efficacy of inactivated mouse brain-derived Hantaan virus vaccine against HFRS are needed.

세가지 조기 임신 진단용 요 HCG Immunoassay 시약의 비교

김미향,이정운,김현숙,권오현 대한임상검사정도관리협회 1992 臨床檢査와 精度管理 Vol.14 No.2

배양방법의 개선이 혐기성 세균 분리에 미친 영향

김현숙,정윤섭,이삼열 대한병리학회 1980 Journal of Pathology and Translational Medicine Vol.14 No.2